Provider Demographics
NPI:1346051505
Name:REVIVAL THERAPY & CONSULTING, LLC
Entity type:Organization
Organization Name:REVIVAL THERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SKYE
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-749-8633
Mailing Address - Street 1:5034 KIDRON RD STE 21
Mailing Address - Street 2:
Mailing Address - City:APPLE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44606-9746
Mailing Address - Country:US
Mailing Address - Phone:330-429-2157
Mailing Address - Fax:
Practice Address - Street 1:5034 KIDRON RD STE 21
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9746
Practice Address - Country:US
Practice Address - Phone:330-429-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health